Anticonvulsant prophylaxis and timing of seizures after aneurysmal subarachnoid hemorrhage
Anticonvulsant prophylaxis and timing of seizures after aneurysmal subarachnoid hemorrhage
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DOI：
10.1212/wnl.55.2.258
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发表时间：
2000-07-25
期刊：
影响因子：
9.9
通讯作者：
Coplin, WM
中科院分区：
文献类型：
--
作者：
Rhoney, DH;Tipps, LB;Coplin, WM
目的：无证据表明动脉瘤性蛛网膜下腔出血(SAH)后可预防癫痫发作。这项研究检查了预防性抗癫痫药物(AED)处方和单一大学附属机构内癫痫发作的发生。方法：采用标准化表格，对95份SAH患者病历进行回顾。变量包括预防持续时间、癫痫发生率和时机、CT表现、AED不良事件和1年患者随访。结果：院前癫痫发生率为17.9%(17/95)，可疑院前癫痫发生率为7.4%(7/95)。4.1%(4/95)的患者发生院内癫痫发作，发作前平均14.5±13.7天；这4名患者中有3名在癫痫发作时正在接受AED治疗。对99%的住院患者开AED，中位数为12天(从1天到68天)。约8%的队列患者有发作后出院发作；这包括有院前或院内癫痫发作的患者，其中50%的患者在癫痫发作时正在接受AED治疗。不良反应发生率为4.1%，无严重不良反应。脑池血块的厚度与癫痫发作有关；没有发现其他临床预测因素。在任何时候癫痫发作都不会对结果产生不利影响。结论：在这一SAH人群中，大多数癫痫发作发生在医学表现之前。院内癫痫发作很少见，对于接受AED预防的患者，发作发生在发病后7天以上。绝大多数假定的临床预测指标并不能帮助预测癫痫发作的发生；只有脑池凝块的厚度对预测癫痫发作有价值。SAH后AED预防的患者选择、有效性和时机值得前瞻性评估。
Objective: There is no evidence that seizure prophylaxis is indicated after aneurysmal subarachnoid hemorrhage (SAH). This study examines prophylactic antiepileptic drug (AED) prescription and the occurrence of seizures within a single university-affiliated institution. Methods: The authors reviewed 95 SAH patient charts using standardized forms. Variables included prophylaxis duration, seizure incidence and timing, CT findings, AED adverse events, and 1-year patient follow-up. Results: Prehospital seizures occurred in 17.9% (17/95) of patients; another 7.4% (7/95) had a questionable prehospital seizure. In-hospital seizures occurred in 4.1% (4/95) of patients, a mean of 14.5 +/- 13.7 days from ictus; three of these four patients were receiving an AED at the time of seizure. Inpatient AED were prescribed to 99% of the cohort for a median of 12 (range 1 to 68) days. Approximately 8% of the cohort had posthospital discharge seizures; this included the patients who had prehospital or in-hospital seizures, 50% of whom were receiving AED therapy at the time of the seizure. Adverse effects occurred in 4.1%; none were serious. The thickness of cisternal clot was associated with having a seizure; no other clinical predictors were identified. Having a seizure at any time did not adversely affect outcome. Conclusions: In this SAH population, the majority of seizures happened before medical presentation. In-hospital seizures were rare and occurred more than 7 days postictus for patients receiving AED prophylaxis. The vast majority of putative clinical predictors did not help predict the occurrence of seizures; only the thickness of the cisternal clot was of value in predicting seizures. Patient selection for and the efficacy and timing of AED prophylaxis after SAH deserve prospective evaluation.